PPassFinals
Vascular SurgeryPending review

Varicose Veins

Dilated, tortuous superficial veins caused by incompetent venous valves that let blood reflux downward and pool under gravity, raising venous pressure until the skin itself begins to fail.

In a nutshell

Varicose veins result from incompetent venous valves letting blood reflux and pool under gravity; the resulting sustained venous hypertension is transmitted to the capillary bed, driving the skin changes and ulceration of chronic venous insufficiency.

Classic presentation

Dilated, tortuous superficial leg veins with aching and heaviness that worsen through the day and with standing, relieved by elevation.

Key points

  • Valves normally prevent gravity-driven reflux; once one fails, the added pressure below can render adjacent valves incompetent too, propagating disease distally.
  • Chronic venous hypertension damages skin via fluid, fibrinogen and red cell leakage into the interstitium, producing haemosiderin pigmentation, lipodermatosclerosis and eventually venous ulceration.
  • Duplex ultrasound is the definitive test, directly visualising reflux duration (over 0.5 seconds) and its source vein.
  • Compression stockings and elevation manage symptoms but do not correct the underlying valve failure: only ablation, sclerotherapy or stripping close or remove the refluxing vein.
  • ABPI should be checked before applying compression, since significant arterial disease is a contraindication to full compression therapy.

First-line investigation

Venous duplex ultrasound, to localise and quantify reflux and exclude deep venous involvement.

First-line management

Endovenous thermal ablation of the incompetent superficial vein for symptomatic or complicated disease; compression and elevation for symptom control.

Exam traps

  • 'Cosmetic' varicose veins still need duplex assessment if symptomatic or associated with skin changes: do not dismiss them as purely aesthetic.
  • Compression bandaging for a venous ulcer requires arterial sufficiency to be confirmed first: applying it with unrecognised coexisting PAD can precipitate ischaemia.
  • Superficial thrombophlebitis near the sapheno-femoral junction needs consideration of anticoagulation, since it can extend into the deep system.

Educational content pending clinical review. Not medical advice.